WHEN Rose Akello, 38, fell horribly ill last month, her high fever and strange bleeding attracted little attention among the squalid mud and wattle huts of Gulu, a town in northern Uganda where people are resigned to disease and accustomed to premature death.

Akello's family nursed her as the blood seeped from every orifice. When she died, they washed her body in preparation for her burial. Other relatives routinely inherited her clothes.

The next day, however, her two-week-old daughter succumbed to the same symptoms. Two days later, it was the turn of the baby's 13-year-old sister. Three days after that, Akello's husband, Alfred Okoya, 42, died, too.

Even in a country ravaged by Aids, the family's sudden demise became a focus of acute concern. When the cause was identified, panic followed. Ebola, one of the deadliest viruses known to man, had struck, and by the time doctors had realised that the Kasubi district of Gulu was at the centre of an outbreak, the disease was already spreading fast.

By this weekend at least 51 people had died and 139 were reported to have been infected by the virus, which produces flu-like symptoms, then attacks the liver and other vital organs, partly dissolving them, and leaving most of those afflicted to bleed to death.

Officials in Gulu insisted the worst of the epidemic was be-hind them. But as an international team of experts - including Dr Simon Mardel, a British doctor from Barrow-in-Furness, Cumbria - fought to contain the virus, the World Health Organisation (WHO) gave a less optimistic prognosis.

Valary Abramov, a WHO spokesman, said it was much too early to predict when the outbreak would reach its peak. "We are now only through the first wave," he said.

Alarmingly, cases of ebola have been reported in Kitgum, the district next to Kasubi. It is believed to have been spread by a nurse who was taken there for burial after she died in Gulu's Lacor hospital, where most of the victims have been treated.

The virus was named after the Ebola River in Congo after its first 280 recorded victims died in the town of Yambuku in 1976. Jungle bats are one suspected source, but scientists have yet to confirm where the virus came from. A second Congo outbreak in 1995 killed 244 people in Kikwit.

Ebola's return has spread terror through Gulu, which is at the centre of a 12-year rebellion by the so-called Lord's Resistance Army and home to nearly 500,000 refugees, many of whom are crowded into camps in conditions ideal for the spread of disease.

Health officials toured last week dispensing advice on how to prevent ebola - passed on by contact with an infected person's body fluids - from running out of control. "We are trying to educate the populace to keep a distance," said Josephine Odongo, a Kasubi councillor. "The response is good. They are getting vigilant."

In Gulu, the traditional handshake has been virtually forsaken. Day schools have been closed, and visitors banned from boarding schools. Only medical staff and soldiers in protective gear are allowed to bury victims in body bags, and funerals must take place immediately.

At one recent funeral, mourners are said to have undressed and abandoned their clothes at the graveside, thinking they might be infected.

Health investigators claim to have identified the first victim of the outbreak as Esther Aweko, who complained of feeling hot, started bleeding from the nose and mouth and was taken to hospital, where she died on September 17.

How she contracted the virus remains unknown. Initial reports suggested that it might been brought into the area by Ugandan soldiers who had fought with rebels in neighbouring Congo. The army claimed the returning soldiers had been sent away immediately for training and had not been in contact with civilians.

Gulu people are less concerned with how the horror began than with who will be the next to die.

Sergeant Galdino Obwoma, a health worker with the army's 4th Division based in Gulu, has lost his sister, Keren Akidi, to the disease. His wife Cecilia and 12-year-old daughter helped to look after her. Now they are also in hospital.

"When my sister died, I buried her immediately and I attended the funerals, but did not touch anything," Obwoma said. "We are ostracised. I went to the office today and nobody wanted to talk to me, so I came back. People are living in fear."

GULU, Uganda (AP) - Scores of Ugandans wept openly Monday as they recounted the horrors of Ebola, the deadly virus that killed many of their loved ones after appearing a year ago in this northern town.

"This disease is terrible. It killed my daughter. ... I will never see her again," said Alice Layalo, pounding the red earth with one hand while clutching the headstone of her daughter's grave with the other.

Ebola, a highly contagious viral fever for which there is no cure, was identified in Gulu, 220 miles north of the capital, Kampala, on Oct. 8, 2000, after dozens of people in the area had died. The virus was later discovered in two other districts and ended up claiming 173 lives, including that of Dr. Matthew Lukwiya, the medical superintendent of St. Mary's hospital in Gulu.

It wasn't until Feb. 27 that the World Health Organization declared Uganda free of Ebola.

On Monday, health officials and relatives of victims attended a ceremony at Gulu cemetery, where wreaths were laid upon the graves of some of the 109 Ebola victims buried there.

Layalo's daughter, Christine Lanyero, was a nurse at Gulu government hospital. She died Dec. 23 after being infected while treating others for the disease.

"My heart becomes almost broken when I come here," said her father, Augustine Arop. "Doctors asked volunteers to come and tend to Ebola patients. Almost no one responded, but my daughter raised her hand."

Health experts said the fast and efficient work of Gulu hospital staff, who used aggressive rehydration therapy on Ebola victims, was responsible for the relatively low death rate.

In other parts of Africa, Ebola outbreaks have killed up to 90 percent of those infected. But Ugandan doctors and international health experts were able to save 60 percent of the patients.

"I was told to take charge of the Ebola isolation ward (at Gulu Hospital) and I froze in my seat ... but I did the work," said Josephine Abu, a nurse. "I got stress ... thinking I had contracted Ebola and kept my gloves and thermometer ready so that in case my temperature rose, people could handle me with the gloves to take me to hospital."

The Ebola outbreak in Gulu was the first recorded in Uganda. At first, Ugandans shunned victims and those who had come into contact with them.

My colleagues no longer (wanted to be) associated with me. From the ward I used to go straight home,'' Abu said, adding that the stigma left after it was clear she was not infected.

The Ebola virus is spread by contact with body fluids, including sweat and saliva. Outbreaks of the disease are rare, and no one knows where the virus lives when it is not infecting humans. The disease usually kills its victims so fast that it also destroys the host for the virus.

Gulu
It all happened on Independence Day. Uganda celebrated yet another anniversary of successful take over from the colonial government and in Gulu district, that 9th day of October 2000, hundreds headed for discotheques to celebrate in style.
Until a bomb, suspected to be hurled by rebels of the Lord's Resistance Army (LRA) brought the party to a screeching halt. Many were injured and others killed, prompting security to ban night discos in the district. As the revellers stumbled out of the dance hall in a daze, they were not aware of an even worse disaster looming outside the screams and bloodshed in the nightclub.
For at about the same time, Dr. Matthew Lukwiya, then Medical Superintendent of St Mary's Hospital Lacor, was on phone to Kampala, telling the ministry of Health how his hospital was recording patients with symptoms similar to those of the deadly haemorrhagic fever Ebola. A South African Laboratory confirmed October 15 it was indeed Ebola, the fever caused by a virus, which caused bleeding from all body openings and could kill within a few days.

There was no turning back for Gulu, Lacor hospital, the Acholi and later two other districts - Mbarara and Masindi. When Dr. Lukwiya made that dreaded phone call, he probably had no idea the discoverer would later also be the victim and on December 5, the world heard that the endeared Dr. Matthew had succumbed to the disease and was in a body bag ready for the unceremonious burial that comes with any Ebola death.

A year later, walking through Gulu is no longer like going through the ghost town Gulu had become during the period the virus was raging on. Business has gone back to normal, the survivors have been integrated in the community, but still, the mention of Ebola or Dr. Matthew draws an emotional sigh.
At the occasion to mark the Ebola out break at Bar dege yesterday, Mrs Lokwiya said she has never recovered from the loss of her husband, so have the children, two of them sitting final examinations (P7 & S4) this year.

"My wife died on November 5 in Lacor hospital after falling sick on Oct. 16. We still remember the hospital ambulance taking her to hospital and later taking her away for burial behind the airstrip. But up to now, whenever my children (one is six, the younger one four years old) see the Lacor ambulance passing by, they run away crying and screaming," Ocan T.K in Bar Dege division told me. "They can never forget that that was the ambulance which took away their mother for ever."

He is one of the lucky few who actually got to bury their loved ones. His wife Lilly Adong was a nursery school teacher at a mission kindergarten, Mary immaculate Nursery School, and when she died, the school administration organised to take him and the children to a place where they could watch the burial proceedings safely.

"Suffering from Ebola wasn't as painful as the effects. It affected us socially and economically. I was a businessman but I can not continue because all the capital went into the hospital," says Walter Odong from Layibi who suffered like 427 other people from Ebola, but survived it. Not unscathed though.

"We are quarrelling with our wives, because most of us are not what we used to be in bed. The erection is there alright, but you cannot perform to the woman's satisfaction. Ebola has really denied us our rights," he said. That is why when the hospital directed that they avoid having sex for at least six months after discharge from hospital, just to be sure the last traces were out, it was easy.

Another survivor Okwera Martin from Kasom Corner says he cannot ride a bicycle, or even remember where he places things after the bout of Ebola fever. He is a carpenter by profession but he cannot do his work like he used to. When he was rushed to hospital Oct 17, he was bleeding profusely from the nose. The nosebleed comes back every few weeks, but people understand it better now, and the survivors attend free clinics at Lacor and Gulu hospitals every two weeks.
What remains are their financial problems to cater for 500 orphans left in the wake of the epidemic.

"Every now and then I get a girl coming with her sisters and brothers to my office for school fees, but I cannot do much. There are unfortunately other orphans due to the war, AIDS yet 60% of Gulu's people leave in camps, so there is not much money in the district," Dr. Paul Onek the District Director of Health Services said. Dr. Onek is also the patron of the association, and he admits the victims will need a lot of support from government and the international community, if their lives are to ever be normal again. It is almost fact that they can never be the same.

However any talk of how Ebola got to Gulu in the first place is still forbidden territory even a year later. It reminded me of the daily press conferences when that was a question that was sure to earn you a disappointed rebuttal from ministry of health officials, that a serious journalist could stick to such an issue.

So with a curt "let's concentrate on controlling the epidemic", the press conference would proceed. A couple of times, it was said investigations were still going on; it will take a while to get those results.

"People had politicised it a lot, until I said look here, let us just get the thing out of here," Onek said when the subject of where from and how came up.

However independent sources from the surveillance team in Gulu told me when the first case was recorded and traced back, it was found that a Captain of the Uganda People's Defence Forces had died in Congo and the body was returned for burial with strict instructions not to open the coffin. Culture, grief and curiosity reportedly took over and the coffin was opened, the ceremonial duties of communal washing, crying and dancing done, and the epidemic was officially ushered in.

"In fact that whole family perished; the grandparents, parents, children, siblings, all died," the source said.

When I put these findings to Onek, he shrugged and said, "you will not get that confirmation from me. Ebola left me so tired, I am not interested in that." I knew that particular interview was over.

The National Ebola Task Force Chairman Dr. Sam Okware also said that could not be true.

"We are still investigating but we don't know up to now and for the next few years there will be no answer to that," Okware said.

Despite worries that if the source couldn't be established for the last Ebola attack, Ugandans could be caught unaware again, there seems to be no answer to this one.

The World Health Organisation and the ministry are still carrying out research on the survivors, but at least despite some of the survivors retaining Ebola-like symptoms, they pose no threat of a fresh outbreak.

According to an Internet report by a combined team of doctors at the ministry, in Gulu, Mbarara and Masindi as well as several NGOs, it is acknowledged that the very first cases of Ebola Haemorrhagic Fever have remained obscure, making it impossible to identify any possible reservoirs of the virus.

What does this mean for Uganda? In Sudan, where the strain we suffered (Ebola-Sudan) first hit in 1976, it re-occurred in 1979 in the same southern towns of Nzara and Maridi. Many Ugandans, especially those leaving in the three most affected districts, live with the fear that after a few years the terror will revisit. But whichever the outcome, Gulu is ready. At Lacor where plans are in final stages to put up a monument in memory of all the fallen health workers during the Ebola fight, the Ag. Medical Superintendent Dr. Cyprian Opira said the hospital is better prepared following the scare.

"We have learnt from the Ebola experience and we now have an infection control committee, so that standard practice is observed even without Ebola, to protect the staff," Opira said.

At the typical mission hospital where everything seems to be done with extra care - even the blue and white nurses' uniforms seem to hold extra starch - it is hard to believe that the hospital once had a dark cloud hanging over it. Business is back to normal, the bed occupancy is at full capacity, the staff who had gone on a panicky strike during the epidemic have returned and the former isolation unit has been transformed into a children's ward after thorough cleaning, repainting and disinfecting.

"We have a problem with the staff. When they see similar symptoms they are hyper vigilant, but I think it is right for them to be alert," Opira, the man doing Lukwiya's job, said.

"It is not possible to fit in Dr. Matthew's shoes, but we try our best. Dr. (Pierre) Corti (the founder of Lacor hospital) misses the support of Dr. Lukwiya so much, but he goes around," he said.

At least the hospital has a few positive things to say about Ebola. The hospital's name is now recognised internationally and as the rest line up at the donors' doors, the Lacor delegation will most likely have an easy match-through. The Austrians have given the hospital an automated laundry to spare the staff from handling the soiled materials from the wards. They have also got an incinerator from other donors.

Gulu Hospital has also benefited from the Italian government. Since the epidemic, the Italians have renovated and equipped the hospital laboratory, built and extended the isolation ward and they are currently building a hostel for the doctors.

That was a relief to hear, because after visiting the immaculate Lacor, my stop over at Gulu Regional Referral Hospital reminded me of all our dear old government hospitals elsewhere. I can't talk about the services authoritatively, but I assure you I wouldn't be surprised if those hospital walls came crashing down on the patients one day

Researchers from the United States and Uganda are examining the blood cells of the 254 Ebola survivors for clues on developing an Ebola vaccine.

Dr. Sam Okware, the commissioner for communicable diseases in the Ministry of Health, said the Uganda Virus Research Institute and the Centre for Disease Control were studying the survivors' blood to discover why they escaped death despite exposure to Ebola.

He told The New Vision last Friday there were plans to develop a vaccine from the blood cells of those who were exposed to the virus but did not contract it.

"They could have built antibodies to neutralise the virus or they survived due to differences in treatment. This is still being studied and if all goes well a vaccine will be ready next year," he said.

He said government had spent over sh3b handling the Ebola outbreak. Of the 425 people that contracted Ebola, 172 died while 254 survived.

GENEVA (AP) - An outbreak of fever in the west African nation of Gabon has been confirmed as the deadly disease Ebola, the World Health Organization said Sunday.

It is the world's first documented outbreak of Ebola since last year in Uganda, where 224 people - including health workers - died from the virus. Ebola is one of the most virulent viral diseases known to humankind, causing death in 50 to 90 percent of all clinically ill cases.

``It's been confirmed by a laboratory in Gabon,'' WHO spokesman Gregory Hartl told The Associated Press. ``We've had reports that seven people have died.''

Hartl said WHO has already sent a team to help the coastal nation and that a second team of four specialists would leave Geneva for Gabon on Monday.

The outbreak is in remote Ogooue Ivindo province in northeastern Gabon, he said. Gabon was last afflicted in an outbreak in 1996-97 that killed 45 of the 60 people infected.

On Friday, Hartl said there were unconfirmed reports of a possible outbreak in Congo, which is near Gabon although the two countries have no common borders.

Ebola is passed through contact with bodily fluids, such as mucus, saliva and blood, but is not airborne. The virus incubates for four to 10 days before flu-like symptoms set in. Eventually, the virus causes severe internal bleeding, vomiting and diarrhea.

There is no cure, but patients treated early for dehydration have a good chance of survival.

GENEVA (AP) - Ten people have died in the latest outbreak of Ebola as experts race to contain the highly contagious disease in the West African nation of Gabon, the United Nations said Monday.

The agency has registered 11 cases, with 10 deaths, said Gregory Hartl, spokesman for the World Health Organization.

The death toll in the usually fatal disease has risen from the reports of seven deaths given Sunday when WHO said it had confirmed that the outbreak of the hemorrhagic fever was in fact Ebola.

Hartl said reports from the outbreak in remote Ogooue Ivindo province in northeastern Gabon were still sketchy but that it appeared there were two clusters ``fairly close together'' - in a village and nearby in the forest.

He said a second team of WHO specialists was being assembled to fly to Gabon on Monday evening, following a group of experts sent out last week.

The team will help Gabon officials in containing the disease, partly by helping local medical staff learn to use ``barriers'' like gloves and masks to prevent contact with the bodily fluids of patients, Hartl said.

It is the first documented outbreak of Ebola since last year in Uganda, where 224 people, including health workers, died from the virus. Ebola is one of the most virulent viral diseases known to humankind, causing death in 50 to 90 percent of all clinically ill cases.

Gabon was last afflicted in an outbreak in 1996-97 that killed 45 of the 60 people infected.

Hartl said Sunday that a laboratory in Franceville, also in eastern Gabon, had confirmed that the disease was Ebola, which has similar symptoms to other, less deadly hemorrhagic fevers.

A team from the Gabon Ministry of Health and the International Center of Medical Research in Franceville went to the province last week when they first received reports that the outbreak might be Ebola, Hartl added.

Ebola is passed through contact with bodily fluids, such as mucus, saliva and blood, but is not airborne. The virus incubates for four to 10 days before flu-like symptoms set in. Eventually, the virus causes severe internal bleeding, vomiting and diarrhea.

There is no cure, but patients treated early for dehydration have a good chance of survival.

WHO says more than 800 people have died of the disease since the virus was first identified in 1976 in western Sudan and in a nearby region of Zaire, now Congo.

Uganda issued an Ebola virus alert on Monday in areas bordering the Democratic Republic of Congo where 28 people died of haemorrhagic fever last week, health officials said.

"We have been hearing of rumours of an outbreak of haemorrhagic fever in Congo and Gabon so we have put the districts on alert just in case it is Ebola," Sam Okware, Uganda's Ebola task force chairman, told Reuters.

Doctors fear the outbreak of fever in the Congolese village of Misangandu, roughly 1,000 km (620 miles) southwest of Uganda, could be the Ebola virus.

There is no known cure or vaccine for Ebola, which causes up to 90 percent of victims to bleed to death in days.

The World Health Organisation said at least 10 other people, including a nurse, had died of a mystery illness in the west African country of Gabon and attributed one of the deaths to the deadly virus.

The biggest recent outbreak of Ebola killed more than 170 people in Uganda last year. The virus is named after the Ebola River where it was first identified in 1976 in the DR Congo.

Ebola, which is passed on through contact with body fluids of infected persons and begins with aches and fever similar to flu symptoms, killed 245 people in the Congolese town of Kikwit in 1995.

Okware said yesterday Ebola can never be too far from anybody. "Distance is not a big deal. One can cross the continent in two hours," he said.

Okware said health workers in the western border districts should screen travellers who enter Uganda. All hospitals should stock medical facilities while health workers look out for patients with fever and bleeding.

Medics caring for UPDF soldiers have also been put on alert and given guidelines.

Meanwhile, Education state minister Henry Okello Oryem has warned that Ebola may strike Uganda again from the Democratic Republic of Congo.

He cautioned the Acholi to be on the alert and keep hygiene.

"Ebola was in Congo and it is back there. We never know, Ebola can come to Uganda again now that it is in Congo. Let us behave as if Ebola is still in Gulu and in this country," Okello said.

Oryem, who represented the Vice-President, Dr. Speciosa Kazibwe, was chief guest yesterday during a requiem service for Dr. Matthew Lukwiya, former medical superintendent of Lacor hospital, who died of Ebola last year.

Oryem, the Chua County MP, urged the people to forget politics and unite to fight diseases.

Lacor chief Dr. Corti Pieru said Ebola would not have spared an Acholi, Italian, partyists or Movementist had the medics not worked hard to contain it.

"We are gathered here today for the memorial service of the late Dr. Matthew Lukwiya, the hero, and other martyrs of Ebola. Dr. Lukwiya ensured that Ebola did not reach Kampala, Arua, Soroti, Lira, Kitgum and Apac districts. They did this by accepting that they were chosen to render service even to the point of death. Let us all join hands to end the suffering of the Acholi," Corti added.

Chief celebrant Kitgum Bishop MackLeod Baker Ochola said Lukwiya's legacy was of love, forgiveness and humanity. He compared him to India's Ghandi.

LIBREVILLE, Gabon (AP) - A World Health Organization team came to the Central African nation of Gabon on Tuesday to help contain an outbreak of the Ebola virus that has killed at least 10 people.

The five-member team - which includes experts from France and the United States - arrived in the capital, Libreville, in the morning and was expected to travel to the affected region in the remote northeastern province of Ogooue Ivindo, near the border with Republic of Congo.

The team will help local authorities isolate and treat victims, as well as distribute protective equipment like gloves and masks to prevent contact with the bodily fluids of patients, WHO officials said.

Gabon's government first reported it suspected an outbreak last Tuesday, after an unusual number of dead primates were found in the region at the same time that local villagers starting falling ill.

On Sunday, WHO officials confirmed the disease was Ebola, which has similar symptoms to other, less deadly hemorrhagic fevers.

Details of the outbreak remained sketchy Tuesday. The government said 10 people had died of the disease and two others were infected, including one in critical condition. WHO had previously reported 11 people had died.

Tests were still being conducted on those who have come into contact with the victims, said provincial health director Dr. Prosper Abessolo-Mengue. While a quarantine has not been imposed on the region, local authorities are monitoring movement to and from the area, he said.

Ogooue Ivindo is one of the most thinly populated regions in Gabon, with isolated, tiny villages surrounded by dense jungle. Ebola last struck the region in 1996-97, killing 45 of the 60 people infected.

``People were very afraid because of what happened in 1997,'' Abessolo-Mengue said. ``But now as we regularly speak to them, and we regularly tell them what we are doing ... the fear has subsided.''

The current outbreak has been pinpointed to the villages of Leahonene and Endemba, he said. The dead include 10 members of an extended family and a nurse who treated at least one of them.

This is the first documented outbreak of Ebola since last year, when 224 people - including health workers - died from the virus in Uganda.

Ebola is one of the most virulent viral diseases known to humankind, causing death in 50 to 90 percent of all clinically ill cases. But it usually kills its victims faster than it can spread, burning out before it can reach too far.

While researchers do not know what causes outbreaks, the virus is believed to be carried by some animals and insects. The disease could then make the jump into a human victim, who spreads it in a community.

The virus is passed through contact with bodily fluids, such as mucus, saliva and blood, but is not airborne. It incubates for four to 10 days before flu-like symptoms set in.

Eventually, the virus causes severe internal bleeding, vomiting and diarrhea. There is no cure, but patients treated early for dehydration have a good chance of survival.

WHO says more than 800 people have died of the disease since the virus was first identified in 1976 in western Sudan and in a nearby region of Zaire, now Congo.
Copyright 2001 The Associated Press

LIBREVILLE, Gabon (AP) - An outbreak of the deadly Ebola disease in Gabon's remote, northeastern jungles appeared to be spreading as the death toll rose Tuesday to 13.

Health authorities have identified 19 suspected cases, World Health Organization spokesman Gregory Hartl said in Geneva. That was three more than Monday, when 12 deaths were reported.

Only two cases have been confirmed through laboratory tests, but medical officials say symptoms in the other 17 cases strongly suggest Ebola, one of the most deadly viral diseases known to mankind.

Health workers were also watching 155 people who have had contact with the victims, Hartl said.

A 14-member team of experts from WHO and the health ministry traveled to Ogooue Ivindo province, where the outbreak began in the central African country. The team was tracing suspected cases and setting up an isolation unit to treat the victims, WHO said.

Ogooue Ivindo, a jungle area inhabited by pygmies and hunter tribes, is one of the most sparsely populated regions in Gabon. Ebola last struck there in 1996-97, killing 45 of the 60 people infected.

The latest outbreak has killed 10 members of an extended family and a nurse who treated one of the victims.

Details of the latest fatalities were not immediately available.

The first death was recorded Dec. 2 in Ekata, about five miles from the Republic of Congo border. Other cases were reported in three nearby villages and two towns, Hartl said.

There were no immediate reports of any suspect fever outbreaks in the neighboring country.

Ebola kills up to 90 percent of those who become infected. There is no cure, but the disease usually kills its victims faster than it can spread, burning out before it can reach too far.

The virus is passed through contact with bodily fluids, such as mucus, saliva and blood. It incubates for four to 10 days. Eventually, the virus causes severe internal bleeding, vomiting and diarrhea.

WHO says over 800 people have died of the disease since the virus was first identified in 1976 in western Sudan and in a nearby region of Congo. The disease last struck in Uganda, killing 224 people last year.

BRAZZAVILLE, Republic of Congo (AP) - Despite stepped-up border controls, an outbreak of the deadly disease Ebola has spread from Gabon to neighboring Republic of Congo, the World Health Organization and government officials said Thursday.

The country's health officials have identified 11 cases in a remote, forested region on the northeastern border with Gabon, where 16 cases have already been reported, WHO said in a statement released in Geneva. The health ministry confirmed the outbreak but said the number of people infected was less than 10.

At least 15 of the victims have died, authorities have said. It was not clear how many of the deaths were in Republic of Congo.

Authorities on both sides of the border had feared the disease would spread and restricted movement between the two central African nations.

But at least one woman believed to be infected with Ebola fled Gabon and was located on the other side of the border in Mbomo village, Republic of Congo health authorities said. The woman's baby died in Republic of Congo before she was repatriated to Gabon, where she also died, health ministry spokesman Bertin Ebinda said.

An international team of medical experts from WHO was working with health officials in both countries to help contain the virus.

Medical staff are tracing everyone who has had contact with any of the known victims and observing them for signs of the virus. A total of 133 contacts are being followed up in Gabon and 94 in Republic of Congo, WHO said.

Local authorities have cordoned off a 125-mile region in Republic of Congo, restricting movement to and from the area. Access is also being restricted to four border villages in Gabon.

The first death was recorded Dec. 2. in Ekata, a Gabon village about five miles from the Republic of Congo border.

At least 10 of the dead were members of a single extended family - a typical pattern for Ebola, which spreads quickly to people coming in contact with the patients or their bodies. A nurse who apparently treated one of the victims also died.

Ebola is one of the most deadly viral diseases known to humankind, causing death in 50 to 90 percent of those who become infected.

The virus is passed through contact with bodily fluids, such as mucus, saliva and blood, but is not airborne. It incubates for four to 10 days before flu-like symptoms set in. Eventually, the virus causes severe internal bleeding, vomiting and diarrhea.

There is no cure, but the disease usually kills its victims faster than it can spread, burning out before it can reach too far.

WHO says over 800 people have died of the disease since the virus was first identified in 1976 in western Sudan and in a nearby region of Congo. The disease last struck in Uganda, killing 224 people last year.

BRAZZAVILLE, Republic of Congo (AP) - Another person has died of Ebola in Central Africa, bringing the death toll from an outbreak of the virus to 18, government officials said Wednesday.

The death occurred in the village of Mbomo and was among 11 known cases of Ebola infection in the Republic of Congo, government spokesman Francois Ibovi said. Seven more people in neighboring Gabon are infected.

With the latest fatality, five people with Ebola have died in Republic of Congo and 13 in neighboring Gabon, World Health Organization spokesman Gregory Hartl said by telephone from Geneva.

The WHO said last week it believes the outbreak has peaked. WHO says 203 people in both countries who have had contact with the infected will be monitored for several weeks for signs and symptoms.

The Ebola cases in Republic of Congo were believed to have come from two sources - an infected Gabonese woman who crossed the border, and people who had eaten primates who had the virus.

While researchers do not know what causes Ebola, the virus is believed to be carried by some animals and insects.

Ebola is one of the most deadly viral diseases known to humankind. There is no cure, and death occurs in 50 to 90 percent of those who contract it.

The virus is passed through contact with bodily fluids, but is not airborne. The disease usually kills its victims faster than it can spread, burning out before it can reach too far.

WHO says over 800 people have died of the disease since the virus was first identified in 1976 in western Sudan and in a nearby region of Congo. The disease last struck in Uganda, killing 224 people last year.

MEKAMBO, Gabon (AP) - A 5-year-old boy died early Friday in an improvised isolation ward as the death toll from an outbreak of the deadly Ebola disease rose to 21 in two Central African nations.

Adamou, who only had one name, was the fifth member of his family to catch the highly contagious disease in the remote town of MeKambo in northeastern Gabon, near the border with Republic of Congo. His mother, a nurse, died after treating an Ebola patient. The disease then spread to her mother, brother and another child.

``My heart is heavy,'' said the child's uncle, John Otolany, whose eldest son remained in the isolation ward concealed behind plastic sheeting at the town's crumbling medical center. ``This disease continues to ravage my family.''

Because of the risk of contagion, Otolany was the only family member present when health workers in rubber boots, plastic overalls, masks, gloves and goggles carried the child out of the ward in a plastic body bag, loaded him onto the back of a truck and transported him to a tiny cemetery in a jungle clearing.

Fighting back tears, Otolany watched as the child was lowered into the grave, sprayed with disinfectant and covered with soil.

Medical officials have identified 17 Ebola cases in Gabon, of whom 15 have died since the outbreak began in late October. Twelve more suspected cases have been identified in Republic of Congo, where six people have died.

The affected region is one of the most thinly populated in both countries. It is covered by vast forests with tiny villages inhabited by Pygmies and other hunter tribes.

A team of medical experts from the World Health Organization and Gabon's health ministry arrived in the region in December and have been working with military doctors to trace victims, treat patients and educate the local population about the disease. The international aid group, Medecins Sans Frontieres, or Doctors Without Borders, is also helping to contain the virus.

In a statement from Geneva, WHO said medical experts were monitoring 206 people - 91 in Gabon and 115 in Republic of Congo - who had possibly come in contact with those infected with the virus.

``We anticipate one or more cases may develop among these contacts,'' the statement said.

WHO, however, has said it believes the outbreak has peaked.

Ebola is one of the most deadly viral diseases. There is no cure, and death occurs in 50 to 90 percent of those who contract it.

The virus is passed through contact with bodily fluids, but is not airborne. The disease usually kills its victims faster than it can spread, burning out before it can reach too far.

The World Health Organization, however, has said it believes the outbreak has peaked.

WHO says over 800 people have died of the disease since the virus was first identified in 1976 in western Sudan and in a nearby region of Congo. The disease last struck in Uganda, killing 224 people last year.

MAKOKOU, Gabon (AP) - Doctors confirmed Saturday that a 16-year-old boy has the Ebola virus and another patient has similar symptoms, prompting fears the deadly disease is continuing to spread in Central Africa.

The boy was admitted last week at Makokou's hospital and tested for Ebola, which already has killed 21 people in Gabon and neighboring Republic of Congo, regional health director Prosper Abessolo Mengue said Saturday.

Another patient was admitted Friday with symptoms of the disease, including fever, diarrhea and vomiting.

Neither patient is known to have had contact with any of the previous victims, raising the possibility of still more unidentified cases.

``This is very worrying,'' said Dr. Julien Meyong, medical chief of the hospital in Makokou, about 360 miles east of the capital, Libreville.

Medical officials have identified 18 Ebola cases in this remote part of Gabon since the outbreak began in late October, according to government figures. Fifteen of those patients died.

Twelve more suspected cases have been identified in neighboring Republic of Congo, with six deaths.

The affected region is one of the most thinly populated in both countries. It is covered by vast forests with tiny villages inhabited by Pygmies and other hunter tribes.

A team of medical experts from the World Health Organization and Gabon's health ministry arrived in December and has been working with military doctors to trace victims, treat patients and educate people about the disease.

The international aid group, Medecins Sans Frontieres, or Doctors Without Borders, also is helping to contain the virus.

Ebola is one of the most deadly viral diseases known to man. The virus is passed through contact with bodily fluids but is not airborne.

There is no cure, and death occurs in up to 90 percent of those who contract it - usually due to massive blood loss. But the disease usually kills its victims faster than it can spread, thus burning out.

Medical experts currently are monitoring 206 people - 91 in Gabon and 115 in Republic of Congo - who may have had contact with those infected with Ebola.

Everyone who had contact with the boy and the other patient - if confirmed to have Ebola - would be added to that list.

WHO says more than 800 people have died of Ebola since the virus was first identified in 1976 in western Sudan and in a nearby region of Congo. The disease last struck in Uganda, killing 224 last year.

MEKAMBO, Gabon (AP) - In a shaded jungle clearing, John Otolany watched grimly as ghostlike men in white protective clothing lowered a small body bag into the ground and sprayed the grave with disinfectant. He then reached for the edge of his T-shirt and wiped away a tear.

Otolany's 5-year-old nephew was the fifth member of his family to die of the Ebola disease. His eldest son died two days later.

This is the fourth time this rare, highly contagious form of hemorrhagic fever has struck Ogooue Ivindo, a remote, northeastern province inhabited by Pygmies and other hunter tribes - and researchers and villagers alike are struggling to explain why.

Rumors abound, blaming everything from plants and monkeys to politics and vampires.

Twenty-three people have died so far in the region - 17 in Gabon and six in neighboring Republic of Congo. In the normally sleepy town of Mekambo, a 10-hour drive down a dirt road that winds through a tangle of brush, trees and vines, the outbreak has caused panic.

The sick refuse to go to the town's crumbling medical center, afraid they will be told they have the disease and isolated from all human contact. Health workers refuse to treat patients. Those with money send their wives and children away for safety.

Otolany's sister, a nurse, was the first in the family to die. She caught the disease from a patient - a typical pattern with Ebola, which is transmitted through bodily fluids and can be passed by a simple handshake.

It is one of the deadliest viral diseases, killing 50 to 90 percent of those who become infected.

The disease can incubate for up to three weeks before flu-like symptoms set in. It then starts attacking internal organs, causing bloody diarrhea and vomiting. Within two weeks, the victim usually is dead from massive blood loss.

There is no cure. But the virus usually kills its victims faster than it can spread, burning out before it can reach too far.

More than 800 people have died of Ebola since it was first identified in 1976 in western Sudan and in a nearby region of Congo, according to the World Health Organization.

Outbreaks are often years and hundreds of miles apart. The disease last struck in Uganda, killing 224 people last year.

Death tolls have been lower in Ogooue Ivindo, the only place in the world where outbreaks have occurred repeatedly. When Ebola last struck the thinly populated province in 1996-97, it killed 45 of the 60 people infected.

Ebola is believed to be carried by some animals and insects that live with the virus in Africa's vast rain forests. But researchers have been unable to pin down the illusive reservoir, in part because of the variety of wildlife.

Most outbreaks begin with a single introduction of the virus into a human, who then spreads the disease in a community. But researchers say this time there is evidence of at least two independent transfers in Gabon and one in Republic of Congo.

This suggests a high number of the virus' natural hosts in the area, or a high proportion of them infected with Ebola, said Dr. Daniel Bausch, a medical epidemiologist with the U.S.-based Centers for Disease Control and Prevention.

Much attention has focused on primates. Gabon's outbreaks have all been accompanied by reports of unusually high numbers of dead chimpanzees, gorillas and other animals.

A 1996 case was even traced to hunters who skinned and chopped a chimpanzee found dead in the forest. But researchers say primates are unlikely to be natural hosts, as they too become sick and die.

Still, authorities have advised local villagers to avoid bush meat for now. But with food scarce, hunters armed with rifles and machetes are still seen carrying dead monkeys home.

Many villagers question whether Ebola really is the cause of the latest deaths, which have mostly been confined to two families.

``If there was Ebola here, the whole village would be dead,'' said Jean-Claude Ndjibadi, who has lost eight members of his extended family.

He still lives in the same mud house in Mendemba, a tiny hunting village about 30 miles east of Mekambo, and sleeps on the same mattress where his brother, sister and mother died.

He blames an ancient family feud - involving tales of theft, murder, adultery and vampires - and accuses a cousin who lived next door of using witchcraft to poison five loved ones. The cousin, his mother and baby have also died.

Most villagers seem to agree with Ndjibadi, and resent WHO's daily visits to monitor all who have had contact with victims. They blame the international medical teams for the difficulties they now have selling their bush meat, cocoa, coffee and other crops - their only source of income.

When a parliamentary vote was postponed in the region, disappointed candidates even started accusing the government of inventing the outbreak for their own political purposes.

Otolany, however, has no doubt that Ebola is ravaging his family and is angry authorities did not act sooner. The outbreak was only officially confirmed Dec. 11, though WHO was notified earlier.

Regional health officials say their efforts were hampered by a critical lack of resources and experienced personnel.

Protective equipment, including gloves and face masks, had to be flown in from the capital, Libreville. Blood samples had to be sent 370 miles south to a laboratory in Franceville. Phone lines are erratic, and the provincial health authority owns just one vehicle.

``We should have had the material in place, as we know Ogooue Ivindo is a region susceptible to outbreaks,'' provincial health director Prosper Abessolo Mengue acknowledged. Next time, he hopes, things will be different.

Just up the hill from John Otalany's house lives his father, Marcellin Otolany. Once one of the village's richest landowners, living surrounded by family, he is now alone.

As he tends the family graves in the tidy front yard, shaded by a flowering tree, he explains with quiet dignity: ``I couldn't abandon the graves of my wife and daughter.''

GENEVA (AP) - International health experts forced to pull out of a remote Gabonese town struck by Ebola met Friday with local officials to discuss security and how to resume their work to keep the disease from spreading.

The 17-member international team and Gabonese health ministry officials left the jungle town of Mekambo on Tuesday because of threats from residents. The outbreak has so far killed 25 people.

Tension has been high in Mekambo and surrounding villages, where many blame outsiders for the difficulties they have had since the outbreak began in Gabon and neighboring Republic of Congo. Rumors are rife that witchcraft and vampires rather than Ebola have caused the deaths.

Efforts by the international team to halt traditional burial practices - such as washing corpses, which increases the risk of spreading the virus - also fed local hostility.

``It can be a question of suspending usual practices - or dying,'' World Health Organization spokesman Gregory Hartl said. ``It comes down to that.''

Hartl said a representative of the U.N. health agency, the aid group Medecins Sans Frontieres and the Gabonese health ministry met Friday in Mekambo, 465 miles northeast of the Gabonese capital, Libreville, to discuss security.

The international Federation of Red Cross and Red Crescent Societies said an international team could return as early as Saturday, but Hartl said no decision has yet been made.

`If the physical safety of all the team members isn't adequate, then we can't ensure proper support for the people of Mekambo,'' he said.

Local Red Cross volunteers have succeeded in dispelling some of the mistrust of outsiders, the Federation of Red Cross and Red Crescent Societies said in its statement Friday.

Ebola is one of the most deadly viral diseases, killing between 50 percent and 90 percent of those who contract it. It spreads through bodily fluids and attacks internal organs, causing bloody diarrhea and vomiting. Within two weeks, the victim usually dies from massive blood loss.

Hartl said WHO was worried about being unable to monitor the more than 200 people who had been in contact with Ebola sufferers. Daily surveillance for symptoms is vital to containing the disease.

So far, 21 cases and 18 fatalities have been confirmed in Gabon and 13 cases and seven fatalities in the Republic of Congo. Medical experts were investigating an additional 16 suspected cases in Gabon.

WHO says more than 1,000 people have died of the disease since the virus was first identified in 1976 in western Sudan and in a nearby region of Congo. The disease last struck in Uganda, killing 224 people last year.

LIBREVILLE, Gabon (AP) - Ebola has claimed five more victims in Gabon, news reports said Friday, bringing the death toll from the disease in two Central African countries to 34.

The new deaths were reported in the remote, northeastern town of Mekambo, Health Minister Faustin Boukoubi was quoted as saying in the state-run newspaper, L'Union.

A total of 26 people have been infected in Gabon, 23 of whom have died, according to World Health Organization figures. An additional 22 people are suspected of having the disease.

Neighboring Republic of Congo has confirmed 16 cases, including 11 deaths, WHO said Thursday.

The five new Gabonese fatalities were reported after an international medical team returned to Mekambo, ending an absence of two weeks prompted by threats from local inhabitants, who blame outsiders for many of their problems.

The team returned last week after talks with provincial and national officials, and with guarantees the local population would be informed about the team's role, Boukoubi said.

Villagers are angry because they can no longer sell their bush meat and crops - their only source of income - because of concern the food might be tainted. Those who have had contact with the victims also resent being confined to their villages for 21 days of medical observation to make sure they don't come down with the disease.

This is the fourth time this rare form of hemorrhagic fever has struck Gabon's Ogooue Ivindo province, a forested region inhabited by Pygmies and other hunter tribes. The latest outbreak began in October.

L'Union quoted Boukoubi as saying rumors about Ebola cases in the capital, Libreville, were a ``false alarm.''

Ebola is one of the most deadly viral diseases and kills between 50 and 90 percent of those who contract it. It spreads through bodily fluids - though not the air - and attacks internal organs, causing bloody diarrhea, vomiting and severe bleeding.

WHO says more than 1,000 people have died of the disease since the virus was first identified in 1976 in western Sudan and in a nearby region of Congo. The disease last struck in Uganda, killing 224 people last year.

The Ministry of Health has put the nine northern districts bordering Sudan on a "high Ebola alert."

This is after a suspected outbreak of Ebola in Ikotos, Torrit County, Southern Sudan. The ministry, however, says there is no confirmation that the decease is Ebola.

The ministry has contacted the World Health Organisation to ascertain the validity of the reports.

"The information is that an outbreak of fever with bleeding from the nose and occasional bloody diarrhea has been reported.

Nine of the cases were positive for malaria, three positive for typhoid and one for dysentery," the release read.

Samples have been taken from the WHO Field Epidermiology Office in Lokilot, for testing at the Kenya Medical Research Institute (KEMRI). Results are due on Wednesday.

A statement from the ministry yesterday stated that so far there have been seven deaths but the number of cases is not known since it's a remote area.

"The border districts of Kitgum, Gulu, Pader, Arua, Adjumani, Moyo, Yumbe and Kotido have been put on high alert and heightened surveillance," the statement signed by J. Kyabaggu for the Director General of Health Service read.

The ministry has drawn up epidemic preparedness and response plans. The UPDF health team has also been informed to be on high alert s there are UPDF in Southern Sudan.

It is also conducting a review of the available logistics and supplies like protective wear and disinfectants at the National Medical Stores, Joint Medical stores and high-risk districts of Gulu and Kitgum.

"In the unfortunate event that the case in Southern Sudan are confirmed to be Ebola, the border districts have been alerted to reactivate the information education campaign messages that were used in the previous Ebola epidemic," the report read.